Surgical instrument manipulator aspects

ABSTRACT

A remote center manipulator for use in minimally invasive robotic surgery includes a base link held stationary relative to a patient, an instrument holder, and a linkage coupling the instrument holder to the base link. First and second links of the linkage are coupled to limit motion of the second link to rotation about a first axis intersecting a remote center of manipulation. A parallelogram linkage portion of the linkage pitches the instrument holder around a second axis that intersects the remote center of manipulation. The second axis is angularly offset from the first axis by a non-zero angle other than 90 degrees.

CROSS-REFERENCES TO RELATED APPLICATIONS

The present application is a Continuation of U.S. patent applicationSer. No. 15/139,224 filed Aug. 11, 2016 (Allowed); which is aContinuation of U.S. patent application Ser. No. 13/906,949 filed May31, 2013 (now U.S. Pat. No. 9,339,344); which claims the benefit of U.S.Provisional Appln No. 61/654,377 filed Jun. 1, 2012; the fulldisclosures which are incorporated herein by reference in their entiretyfor all purposes.

BACKGROUND

Minimally invasive medical techniques are intended to reduce the amountof extraneous tissue that is damaged during diagnostic or surgicalprocedures, thereby reducing patient recovery time, discomfort, anddeleterious side effects. One effect of minimally invasive surgery, forexample, is reduced post-operative hospital recovery times. Because theaverage hospital stay for a standard open surgery is typicallysignificantly longer than the average stay for an analogous minimallyinvasive surgery, increased use of minimally invasive techniques couldsave millions of dollars in hospital costs each year. While many of thesurgeries performed each year in the United States could potentially beperformed in a minimally invasive manner, only a portion of the currentsurgeries use these advantageous techniques due to limitations inminimally invasive surgical instruments and the additional surgicaltraining involved in mastering them.

Minimally invasive robotic surgical or telesurgical systems have beendeveloped to increase a surgeon's dexterity and avoid some of thelimitations on traditional minimally invasive techniques. Intelesurgery, the surgeon uses some form of remote control (e.g., aservomechanism, or the like) to manipulate surgical instrumentmovements, rather than directly holding and moving the instruments byhand. In telesurgery systems, the surgeon can be provided with an imageof the surgical site at a surgical workstation. While viewing a two- orthree-dimensional image of the surgical site on a display, the surgeonperforms the surgical procedures on the patient by manipulating mastercontrol devices, which in turn control motion of the servo-mechanicallyoperated slave instruments.

The servomechanism used for telesurgery will often accept input from twomaster controllers (one for each of the surgeon's hands) and may includetwo or more robotic arms on each of which a surgical instrument ismounted. Operative communication between master controllers andassociated robotic arm and instrument assemblies is typically achievedthrough a control system. The control system typically includes at leastone processor that relays input commands from the master controllers tothe associated robotic arm and instrument assemblies and back from theinstrument and arm assemblies to the associated master controllers inthe case of, for example, force feedback or the like. One example of arobotic surgical system is the DA VINCI® system commercialized byIntuitive Surgical, Inc. of Sunnyvale, Calif.

A variety of structural arrangements have been used to support thesurgical instrument at the surgical site during robotic surgery. Thedriven linkage or “slave” is often called a robotic surgicalmanipulator, and exemplary linkage arrangements for use as a roboticsurgical manipulator during minimally invasive robotic surgery aredescribed in U.S. Pat. No. 7,594,912 (filed Sep. 30, 2004), U.S. Pat.No. 6,758,843 (filed Apr. 26, 2002), U.S. Pat. No. 6,246,200 (filed Aug.3, 1999), and U.S. Pat. No. 5,800,423 (filed Jul. 20, 1995), the fulldisclosures of which are incorporated herein by reference. Theselinkages often manipulate an instrument holder to which an instrumenthaving a shaft is mounted. Such a manipulator structure can include aparallelogram linkage portion that generates motion of the instrumentholder that is limited to rotation about a pitch axis that intersects aremote center of manipulation located along the length of the instrumentshaft. Such a manipulator structure can also include a yaw joint thatgenerates motion of the instrument holder that is limited to rotationabout a yaw axis that is perpendicular to the pitch axis and that alsointersects the remote center of manipulation. By aligning the remotecenter of manipulation with the incision point to the internal surgicalsite (for example, with a trocar or cannula at an abdominal wall duringlaparoscopic surgery), an end effector of the surgical instrument can bepositioned safely by moving the proximal end of the shaft using themanipulator linkage without imposing potentially hazardous forcesagainst the abdominal wall. Alternative manipulator structures aredescribed, for example, in U.S. Pat. No. 6,702,805 (filed Nov. 9, 2000),U.S. Pat. No. 6,676,669 (filed Jan. 16, 2002), U.S. Pat. No. 5,855,583(filed Nov. 22, 1996), U.S. Pat. No. 5,808,665 (filed Sep. 9, 1996),U.S. Pat. No. 5,445,166 (filed Apr. 6, 1994), and U.S. Pat. No.5,184,601 (filed Aug. 5, 1991), the full disclosures of which areincorporated herein by reference.

While the new telesurgical systems and device have proven highlyeffective and advantageous, still further improvements would bedesirable. In general, it would be desirable to provide improvedstructures and systems for performing minimally invasive roboticsurgery. More specifically, it would be beneficial to enhance theefficiency and ease of use of these systems. For example, it would beparticularly beneficial to improve the range of motion provided by therobotic surgical manipulator without imposing potentially hazardousforces against the abdominal wall.

BRIEF SUMMARY

The following presents a simplified summary of some embodiments of theinvention in order to provide a basic understanding of the invention.This summary is not an extensive overview of the invention. It is notintended to identify key/critical elements of the invention or todelineate the scope of the invention. Its sole purpose is to presentsome embodiments of the invention in a simplified form as a prelude tothe more detailed description that is presented later.

Improved remote center manipulators are disclosed that support asurgical instrument and provide a center of manipulation, remote fromany bearings or mechanical supports, at a desired location of theinstrument during minimally invasive robotic surgery. The remote centermanipulator constrains the instrument to move around the remote centerof manipulation, which is preferably coincident with an entry incisionin a patient, such as the patient's abdominal wall. The improved remotecenter manipulators include a linkage that couples a surgical instrumentholder to a mounting base. The linkage is operable to rotate theinstrument holder about a yaw axis that intersects the remote center ofmanipulation and to rotate (pitch) the instrument holder about a pitchaxis that also intersects the remote center of manipulation. The pitchaxis is transverse, but not perpendicular, to the yaw axis, therebyserving to reduce the operational space envelope of the improvedmanipulators. And in many embodiments, the linkage includes links thatmove in separate planes of motion, thereby providing freedom of motionnot possible with links that move in the same plane of motion.

Thus, in one aspect, a remote center manipulator for constraining aposition of a surgical instrument during minimally invasive roboticsurgery is disclosed. The surgical instrument includes an elongate shafthaving a distal working end configured for insertion into a body cavityof a patient through a remote center of manipulation. The remote centermanipulator includes a mounting base, an instrument holder configured tocouple with the surgical instrument, and a linkage coupling theinstrument holder to the mounting base. First and second links of thelinkage are coupled to limit motion of the second link relative to thefirst link to rotation about a yaw axis that intersects the remotecenter of manipulation. The linkage includes three rotationally coupledjoints configured to generate constrained parallelogram motion of thelinkage by which motion of the instrument holder is limited to rotationabout a pitch axis that intersects the remote center of manipulation.The pitch axis is angularly offset from the yaw axis by a non-zero angleother than 90 degrees.

In many embodiments, the yaw axis and the pitch axis deviate from beingperpendicular by an angle suitable for minimizing the operational spaceenvelope of the remote center manipulator during rotation of theinstrument holder about the yaw axis. For example, in many embodimentsthe yaw axis and the pitch axis deviate from being perpendicular by anangle of 1.0 to 10.0 degrees. In many embodiments, the yaw axis and thepitch axis deviate from being perpendicular by an angle of 1.5 to 5.0degrees. And in many embodiments, the yaw axis and the pitch axisdeviate from being perpendicular by an angle of 2.0 to 3.5 degrees.

In many embodiments, the remote center manipulator is configured toprovide a large range of motion of the instrument holder around the yawaxis. For example, in many embodiments the second link can be rotatedrelative to the first link through at least 540 degrees. And in manyembodiments, the second link can be rotated relative to the first linkthrough at least 600 degrees.

In many embodiments, the remote center manipulator is configured toprovide a large range of motion of the instrument holder around thepitch axis. For example, in many embodiments the instrument holder canbe rotated about the pitch axis through at least 140 degrees.

In another aspect, a remote center manipulator for constraining aposition of a surgical instrument during minimally invasive roboticsurgery is disclosed. The surgical instrument includes an elongate shafthaving a distal working end configured for insertion into a body cavityof a patient through a remote center of manipulation. The remote centermanipulator includes a mounting base, a parallelogram linkage base, afirst drive module, a second drive module, a first link, a second link,and an instrument holder. The parallelogram linkage base is coupled tothe mounting base for rotation relative to the mounting base about a yawaxis that intersects the remote center of manipulation. The first drivemodule drivingly couples the parallelogram linkage base to the mountingbase to selectively rotate the parallelogram base relative to themounting base about the yaw axis. The second drive module isrotationally coupled to the parallelogram linkage base and has a seconddrive module output. The second drive module is configured toselectively rotate the second drive module output relative to theparallelogram linkage base. The first link has a first link proximal endand a first link distal end. The first link proximal end is coupled tothe parallelogram base for rotation relative to the parallelogram basein response to rotation of the second drive module output. The secondlink has a second link proximal end and a second link distal end. Thesecond link proximal end is coupled to the first link distal end forrotation relative to the first link in response to rotation of thesecond drive module output. The instrument holder is coupled to thesecond link proximal end for rotation relative to the second link inresponse to rotation of the second drive module output. Rotation of thesecond drive module output generates motion of the instrument holderthat is limited to rotation about a pitch axis that intersects theremote center of manipulation. The pitch axis is angularly offset fromthe yaw axis by a non-zero angle other than 90 degrees. A common drivemodule can be used for each of the first and second drive modules.

In many embodiments, the parallelogram linkage base includes a yaw/pitchhousing. In many embodiments, each of the first and second drive modulesis at least partially disposed within the yaw/pitch housing.

In many embodiments, the parallelogram linkage base includes anextension having an extension proximal end and an extension distal end.The extension proximal end is fixedly attached to the yaw/pitch housing.The first link proximal end is coupled to the extension distal end forrotation relative to the extension in response to rotation of the seconddrive module output. In many embodiments, the extension includes a drivecoupling that drivingly couples rotation of the second link to rotationof the second drive module output. The drive coupling extends betweenthe extension proximal end and the extension distal end. In manyembodiments, the drive coupling includes a metal belt that drivinglycouples pulleys. In many embodiments, the drive coupling includesSine/Cosine links. And in many embodiments, the drive coupling includesSine/Cosine links with oriented flexures.

The remote center manipulator can be made from one or more replaceableunits. For example, the remote center manipulator can include firstthrough fifth separate field replaceable units. The first fieldreplaceable unit includes the yaw/pitch housing, the first drive module,the second drive module, and the second drive module output. The secondfield replaceable unit includes the extension. The third fieldreplaceable unit includes the first link. The fourth field replaceableunit includes the second link. And the fifth replaceable unit includesthe instrument holder.

In many embodiments, the remote center manipulator is configured toavoid interference between components of the manipulator. For example,the extension can be offset to one side of the first link such that thefirst link is movable into alignment with the extension. And the secondlink can be offset to one side of the first link such that the secondlink is movable into alignment with the first link.

In many embodiments, the remote center manipulator is configured toprovide a large range of motion of the instrument holder around the yawaxis. For example, in many embodiments the parallelogram base can berotated relative to the mounting base through at least 540 degrees. Andin many embodiments, the parallelogram base can be rotated relative tothe mounting base through at least 600 degrees.

In many embodiments, the remote center manipulator is configured toprovide a large range of motion of the instrument holder around thepitch axis. For example, in many embodiments the instrument holder canbe rotated about the pitch axis through at least 140 degrees.

In many embodiments, the yaw axis and the pitch axis deviate from beingperpendicular by an angle suitable for minimizing the operational spaceenvelope of the remote center manipulator during rotation of theinstrument holder about the yaw axis. For example, in many embodimentsthe yaw axis and the pitch axis deviate from being perpendicular by anangle of 1.0 to 10.0 degrees. In many embodiments, the yaw axis and thepitch axis deviate from being perpendicular by an angle of 1.5 to 5.0degrees. And in many embodiments, the yaw axis and the pitch axisdeviate from being perpendicular by an angle of 2.0 to 3.5 degrees.

For a fuller understanding of the nature and advantages of the presentinvention, reference should be made to the ensuing detailed descriptionand accompanying drawings. Other aspects, objects and advantages of theinvention will be apparent from the drawings and detailed descriptionthat follows.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a plan view of a minimally invasive robotic surgery systembeing used to perform a surgery, in accordance with many embodiments.

FIG. 2 is a perspective view of a surgeon's control console for arobotic surgery system, in accordance with many embodiments.

FIG. 3 is a perspective view of a robotic surgery system electronicscart, in accordance with many embodiments.

FIG. 4 diagrammatically illustrates a robotic surgery system, inaccordance with many embodiments.

FIG. 5A is a front view of a patient side cart (surgical robot) of arobotic surgery system, in accordance with many embodiments.

FIG. 5B is a front view of a robotic surgery tool, in accordance withmany embodiments.

FIG. 6 is a perspective schematic representation of a remote centermanipulator, in accordance with many embodiments, that includes aconical sweep joint operable to reorient an instrument holder withoutmoving a remote center of manipulation.

FIG. 7 is a perspective schematic representation of a remote centermanipulator, in accordance with many embodiments, that includes aconical sweep link operable to reorient the outboard portion of themanipulator without moving a remote center of manipulation.

FIG. 8 is a perspective schematic representation of a remote centermanipulator, in accordance with many embodiments, that includes theconical sweep joint of FIG. 6 and the conical sweep link of FIG. 7 .

FIG. 9 is a perspective schematic representation of a remote centermanipulator, in accordance with many embodiments, that includes a pitchlinkage operable to reorient the outboard portion of the manipulatorwithout moving a remote center of manipulation.

FIG. 10 is a perspective schematic representation of the a remote centermanipulator, in accordance with many embodiments, that includes theconical sweep joint of FIG. 6 , the conical sweep link of FIG. 7 , andthe pitch linkage of FIG. 9 .

FIG. 11 shows a remote center manipulator, in accordance with manyembodiments, that includes a conical sweep link operable to reorientlinkage assemblies of the manipulator without moving a remote center ofmanipulation.

FIG. 12 shows a remote center manipulator, in accordance with manyembodiments, that includes a conical sweep joint operable to reorient aninstrument holder without moving a remote center of manipulation.

FIGS. 13A, 13B, and 13C show the remote center manipulator of FIG. 8Awith the instrument holder in different orientations.

FIG. 14A illustrates Sine/Cosine links that can be used to rotationallycouple two parallelogram joints in the remote center manipulator of FIG.8A, in accordance with many embodiments.

FIG. 14B illustrates oriented flexures that serve to alleviateforce-fight induced loads in links used to rotationally couple twoparallelogram joints in a remote center manipulator, in accordance withmany embodiments.

FIG. 15 shows a remote center manipulator, in accordance with manyembodiments, that includes a curved feature having a constant radius ofcurvature relative to the remote center of manipulation and along whicha base link of the outboard linkage can be repositioned.

FIG. 16 shows a remote center manipulator, in accordance with manyembodiments, that includes a closed-loop curved feature to which a baselink of the outboard linkage is interfaced such that the base link isconstrained to move along the closed-loop curved feature.

FIG. 17 is a perspective schematic representation of a remote centermanipulator, in accordance with many embodiments, in which an instrumentholder is rotated around a pitch axis through a remote center androtated around a yaw axis through the remote center, the pitch axisbeing non-perpendicular to the yaw axis.

FIG. 18 is a perspective schematic representation of a remote centermanipulator, in accordance with many embodiments, in which the remotecenter manipulator of FIG. 17 further includes the pitch linkage of FIG.9 .

FIG. 19 is a perspective schematic representation of the remote centermanipulator, in accordance with many embodiments, that in which theremote center manipulator of FIG. 18 further includes the conical sweepjoint of FIG. 6 .

FIG. 20 is a side view of a remote center manipulator, in accordancewith many embodiments.

FIG. 21 is a top view of the remote center manipulator of FIG. 20 .

FIG. 22 illustrates a reduction in operating space envelope of theremote center manipulator of FIG. 20 achieved by skewing the pitch axis.

FIG. 23 is a side view of the remote center manipulator of FIG. 20 in aconfiguration of maximum pitch back of the instrument holder relative tothe remote center of manipulation, in accordance with many embodiments.

DETAILED DESCRIPTION

In the following description, various embodiments of the presentinvention will be described. For purposes of explanation, specificconfigurations and details are set forth in order to provide a thoroughunderstanding of the embodiments. However, it will also be apparent toone skilled in the art that the present invention may be practicedwithout the specific details. Furthermore, well-known features may beomitted or simplified in order not to obscure the embodiment beingdescribed.

Minimally Invasive Robotic Surgery

Referring now to the drawings, in which like reference numeralsrepresent like parts throughout the several views, FIG. 1 is a plan viewillustration of a Minimally Invasive Robotic Surgical (MIRS) system 10,typically used for performing a minimally invasive diagnostic orsurgical procedure on a Patient 12 who is lying on an Operating table14. The system can include a Surgeon's Console 16 for use by a Surgeon18 during the procedure. One or more Assistants 20 may also participatein the procedure. The MIRS system 10 can further include a Patient SideCart 22 (surgical robot) and an Electronics Cart 24. The Patient SideCart 22 can manipulate at least one removably coupled tool assembly 26(hereinafter referred to as a “tool”) through a minimally invasiveincision in the body of the Patient 12 while the Surgeon 18 views animage of the surgical site through the Console 16. An image of thesurgical site can be obtained by an endoscope 28, such as a stereoscopicendoscope, which can be manipulated by the Patient Side Cart 22 toposition and orient the endoscope 28. The Electronics Cart 24 can beused to process the images of the surgical site for subsequent displayto the Surgeon 18 through the Surgeon's Console 16. The number ofsurgical tools 26 used at one time will generally depend on thediagnostic or surgical procedure and the space constraints within theoperating room, among other factors. If it is necessary to change one ormore of the tools 26 being used during a procedure, an Assistant 20 mayremove the tool 26 from the Patient Side Cart 22 and replace it withanother tool 26 from a tray 30 in the operating room.

FIG. 2 is a perspective view of the Surgeon's Console 16. The Surgeon'sConsole 16 includes a left eye display 32 and a right eye display 34 forpresenting the Surgeon 18 with a coordinated stereo view of the surgicalsite that enables depth perception. The Console 16 further includes oneor more input control devices 36, which in turn cause the Patient SideCart 22 (shown in FIG. 1 ) to manipulate one or more tools. The inputcontrol devices 36 can provide the same degrees of freedom as theirassociated tools 26 (shown in FIG. 1 ) to provide the Surgeon withtelepresence, or the perception that the input control devices 36 areintegral with the tools 26 so that the Surgeon has a strong sense ofdirectly controlling the tools 26. To this end, position, force, andtactile feedback sensors (not shown) may be employed to transmitposition, force, and tactile sensations from the tools 26 back to theSurgeon's hands through the input control devices 36. Each individualinput control device 36 acts as a human-controlled master to control acorresponding slave surgical tool to enable teleoperation. Thetelepresence sensation is enabled when this teleoperation is combinedwith the display of the surgical site perceived in three dimensions andthe surgeon's hand positioned on a master at a position correspondingwith the viewed tool image at the surgical site.

The Surgeon's Console 16 is usually located in the same room as thepatient so that the Surgeon may directly monitor the procedure, bephysically present if necessary, and speak to an Assistant directlyrather than over the telephone or other communication medium. However,the Surgeon can be located in a different room, a completely differentbuilding, or other remote location from the Patient allowing for remotesurgical procedures.

FIG. 3 is a perspective view of the Electronics Cart 24. The ElectronicsCart 24 can be coupled with the endoscope 28 and can include a processorto process captured images for subsequent display, such as to a Surgeonon the Surgeon's Console, or on another suitable display located locallyand/or remotely. For example, where a stereoscopic endoscope is used,the Electronics Cart 24 can process the captured images to present theSurgeon with coordinated stereo images of the surgical site. Suchcoordination can include alignment between the opposing images and caninclude adjusting the stereo working distance of the stereoscopicendoscope. As another example, image processing can include the use ofpreviously determined camera calibration parameters to compensate forimaging errors of the image capture device, such as optical aberrations.

FIG. 4 diagrammatically illustrates a robotic surgery system 50 (such asMIRS system 10 of FIG. 1 ). As discussed above, a Surgeon's Console 52(such as Surgeon's Console 16 in FIG. 1 ) can be used by a Surgeon tocontrol a Patient Side Cart (Surgical Robot) 54 (such as Patent SideCart 22 in FIG. 1 ) during a minimally invasive procedure. The PatientSide Cart 54 can use an imaging device, such as a stereoscopicendoscope, to capture images of the procedure site and output thecaptured images to an Electronics Cart 56 (such as the Electronics Cart24 in FIG. 1 ). As discussed above, the Electronics Cart 56 can processthe captured images in a variety of ways prior to any subsequentdisplay. For example, the Electronics Cart 56 can overlay the capturedimages with a virtual control interface prior to displaying the combinedimages to the Surgeon via the Surgeon's Console 52. The Patient SideCart 54 can output the captured images for processing outside theElectronics Cart 56. For example, the Patient Side Cart 54 can outputthe captured images to a processor 58, which can be used to process thecaptured images. The images can also be processed by a combination theElectronics Cart 56 and the processor 58, which can be coupled togetherto process the captured images jointly, sequentially, and/orcombinations thereof. One or more separate displays 60 can also becoupled with the processor 58 and/or the Electronics Cart 56 for localand/or remote display of images, such as images of the procedure site,or other related images.

FIGS. 5A and 5B show a Patient Side Cart 22 and a surgical tool 62,respectively. The surgical tool 62 is an example of the surgical tools26. The Patient Side Cart 22 shown provides for the manipulation ofthree surgical tools 26 and an imaging device 28, such as a stereoscopicendoscope used for the capture of images of the site of the procedure.Manipulation is provided by robotic mechanisms having a number ofrobotic joints. The imaging device 28 and the surgical tools 26 can bepositioned and manipulated through incisions in the patient so that akinematic remote center of motion is maintained at the incision tominimize the size of the incision. Images of the surgical site caninclude images of the distal ends of the surgical tools 26 when they arepositioned within the field-of-view of the imaging device 28. Adiagnostic or therapeutic end effector 63 is typically at the distal endof the surgical instrument's long shaft.

Hardware-Constrained Remote Center Manipulators

FIG. 6 is a perspective schematic representation of a remote centermanipulator 70, in accordance with many embodiments. The remote centermanipulator 70 is supported from a mounting base 72. The remote centermanipulator 70 includes a base link 74 that is supported by the mountingbase 72, a yaw joint 76, an extension link 78, a base parallelogramjoint 80, a first parallelogram link 82, a first parallelogram joint 84,a second parallelogram link 86, a second parallelogram joint 88, aconical sweep mechanism 90, and an instrument holder 92. The instrumentholder 92 is configured to support and translate a surgical instrument94 along an insertion axis 96 (i.e., instrument holder 92 includes atleast one prismatic joint that moves surgical instrument 94 in and outof the incision at the patient's body wall or at the patient's naturalbody orifice along insertion axis 96). A surgical end effector 95 is atthe distal end of surgical instrument 94. The end effector may be forany surgical function, including therapeutic, diagnostic, or imagingsurgical devices. End effector roll may be done in various known ways.For example, instrument holder 92 or instrument 94 itself may include aninstrument shaft roll capability that allows the instrument shaft toroll around insertion axis 96. As an alternative example, the shaft mayremain stationary in roll, and the end effector rolls at the end of theinstrument shaft.

The mounting base 72 allows the remote center manipulator 70 to bemounted and supported by set-up arms/joints of a cart mount, a ceilingmount, floor/pedestal mount, or other mounting surface so that the baseremains effectively stationary in a ground reference frame (asrepresented by the ground symbol). The remote center manipulator 70 isconfigured such that the remote center of manipulation (RC) does notmove relative to the mounting base 72 as the surgical instrument 94 ismanipulated. By supporting the mounting base 72 in a fixed position andorientation relative to a patient, a remote center of manipulation (RC)is held fixed relative to the patient, thereby providing an entry pointfor the surgical instrument 94. With the remote center of manipulation(RC) fixed relative to the patient, the manipulation of the surgicalinstrument 94 can be accomplished without the risk of imposingpotentially hazardous forces on patient tissue at the entry location ofthe surgical instrument 94. In embodiments in which the surgicalinstrument shaft passes through a cannula, the remote center ofmanipulation is typically defined at a point along the cannula'scenterline, although in some embodiments a cannula may be optional.

The yaw joint 76 rotationally couples the proximal end of the extensionlink 78 to the distal end of the base link 74. The yaw joint 76 isoperable to produce controlled rotation (roll) of the extension link 78about a yaw axis 98 that extends through the remote center ofmanipulation (RC). Because the instrument holder 92 is coupled to theextension link 78 via the intervening linkage components of the remotecenter manipulator 70, rotation (roll) of the extension link 78 aboutthe yaw axis 98 generates corresponding rotation of the instrumentholder 92 about the yaw axis 98, thereby maintaining the position andorientation of the remote center of manipulation (RC) relative to themounting base 72 for all angular orientations of the yaw joint 76. Theterm “yaw” is arbitrary, and under this term it can be seen that withthe remote center of manipulation (RC) stationary, rotation around yawaxis 98 will cause the distal tip of surgical instrument 94 to move in away defined as yaw.

A parallelogram linkage portion 100 of the remote center manipulator 70is configured to produce motion of the instrument holder 92 that islimited to rotation about a pitch axis 102 that intersects the remotecenter of manipulation (RC). By limiting the corresponding movement ofthe instrument holder 92 to rotation (pitch) about the pitch axis 102,the insertion axis 96 continually intersects the remote center ofmanipulation (RC) and the distance between the instrument holder 92 andthe remote center of manipulation (RC) is maintained. The term “pitch”is arbitrary, and under this term it can be seen that with the remotecenter of manipulation (RC) stationary, rotation around pitch axis 102will cause the distal tip of surgical instrument 94 to move in a waydefined as pitch.

The parallelogram linkage portion 100 includes the parallelogram basejoint 80, the first parallelogram link 82, the first parallelogram joint84, the second parallelogram link 86, the second parallelogram joint 88,the conical sweep mechanism 90, and the instrument holder 92. The baseparallelogram joint 80 rotationally couples the proximal end of thefirst parallelogram link 82 to the distal end of the extension link 78.The base parallelogram joint 80 is operable to produce controlledrotation of the first parallelogram link 82 about a base joint axis 104that is parallel to the pitch axis 102. The position and orientation ofthe base joint axis 104 is fixed relative to the extension link 78. Thefirst parallelogram joint 84 rotationally couples the proximal end ofthe second parallelogram link 86 to the distal end of the firstparallelogram link 82 for rotation of the second parallelogram link 86about a first joint axis 106 that is parallel to the pitch axis 102. Theposition and orientation of the first joint axis 106 is fixed relativeto the first parallelogram link 82. The second parallelogram joint 88rotationally couples the proximal end of the conical sweep mechanism 90to the distal end of the second parallelogram link 86 for rotation ofthe conical sweep mechanism 90 about a second joint axis 108 that isparallel to the pitch axis 102. The position and orientation of thesecond joint axis 108 is fixed relative to the second parallelogram link86. Because the instrument holder 92 is coupled to the distal end of theconical sweep mechanism 90, the instrument holder 92 is constrained torotate about the second joint axis 108.

The first and second parallelogram joints 84, 88 are rotationallycoupled to the base parallelogram joint 80 so that actuation of the baseparallelogram joint 80 actuates the parallelogram linkage portion 100,thereby generating corresponding motion of the instrument holder 92 thatis limited to rotation about the pitch axis 102. Any suitable approachcan be used to rotationally couple the base parallelogram joint 80, thefirst parallelogram joint 84, and the second parallelogram joint 88. Forexample, the base parallelogram joint 80 can include a base pulley thatis rotationally fixed to the extension link 78 and mounted to rotaterelative to the first parallelogram link 82 around the base joint axis104. The first parallelogram joint 84 can include a first pulley that isrotationally fixed to the second parallelogram link 86 and mounted torotate relative to the first parallelogram link 82 around the firstjoint axis 106. By tying the rotation of the first pulley to rotation ofthe second pulley, for example by one or more drive belts or one or morelinks, rotation of the second parallelogram link 86 relative to thefirst parallelogram link 82 can be driven by rotation of the firstparallelogram link 82 relative to the extension link 78 such that thesame relative orientation between the second parallelogram link 86 andthe extension link 78 is maintained for all angular orientation of thefirst parallelogram link 82 relative to the extension link 78. In a likemanner, the first parallelogram joint 84 can include a third pulley thatis rotationally fixed to the first parallelogram link 82 and mounted torotate relative to the second parallelogram link 86 around the firstjoint axis 106. The second parallelogram joint 88 can include a fourthpulley that is rotationally fixed to the proximal end of the conicalsweep mechanism 90 and mounted to rotate relative to the secondparallelogram link 86 around the second joint axis 108. By tying therotation of the third pulley to rotation of the fourth pulley, forexample by one or more drive belts or one or more links, rotation of theconical sweep mechanism 90 relative to the second parallelogram link 86can be driven by rotation of the second parallelogram link 86 relativeto the first parallelogram link 82 such that the same relativeorientation between the insertion axis 96 and the first parallelogramlink 82 is maintained for all angular orientation of the secondparallelogram link 86 relative to the first parallelogram link 82.

The conical sweep mechanism 90 includes a proximal conical sweep link110 and a conical sweep joint 112. The conical sweep joint 112rotationally couples the instrument holder 92 to the proximal conicalsweep link 110 such that actuation of the conical sweep joint 112reorients the instrument holder 92 relative to the proximal conicalsweep link 110 about a conical sweep axis 114 that intersects the remotecenter of manipulation (RC). Rotation of conical sweep joint 112 causesthe shaft of surgical instrument 94 to sweep along the surface of a conecentered on conical sweep axis 114 and having a vertex at the remotecenter of manipulation (RC). Reorientation of the instrument holder 92about the conical sweep axis 114 can be used for any suitable purpose,such as for collision avoidance with an adjacent surgical manipulatorand/or the patient, or for providing increased space at the body wall toallow surgical personnel to access the sterile surgical field where theinstrument enters the body. Reorientation of the instrument holder 92about the conical sweep axis 114 can also be used to extend theavailable movement range of the instrument holder 92 relative to thepatient. The conical sweep axis 114 provides one redundant axis aboutwhich the instrument holder 92 can be rotated around the remote centerof manipulation (RC). The conical sweep axis 114 is not aligned with anyof the yaw axis 98, the pitch axis 102, or the insertion axis 96. Inoperation, however, the angle between the conical sweep axis 114 and theyaw axis 98 can change as the remote center manipulator 70 isarticulated. Conical sweep mechanism 90 is optional and may be includedor not with various manipulator embodiments as described herein. Forpurposes of this description, conical sweep mechanism 90 may beconsidered a distal conical sweep mechanism to distinguish it from otherconical sweep mechanisms located more proximally in the manipulator (seee.g., FIG. 8 in which another, “proximal” conical sweep mechanism isshown).

FIG. 7 is a perspective schematic representation of a remote centermanipulator 120, in accordance with many embodiments. The remote centermanipulator 120 includes some of the same components as the remotecenter manipulator 70 of FIG. 6 . The shared components include themounting base 72, the base link 74, the yaw joint 76, the extension link78, the base parallelogram joint 80, the first parallelogram link 82,the first parallelogram joint 84, the second parallelogram link 86, thesecond parallelogram joint 88, and the instrument holder 92. The remotecenter manipulator 120 does not include the conical sweep mechanism 90.Instead, the second parallelogram joint 88 rotationally couples theinstrument holder 92 to the second parallelogram link 86 for rotation ofthe instrument holder 92 relative to the second parallelogram link 86about the second joint axis 108.

The remote center manipulator 120 further includes a conical sweepmechanism 122. The conical sweep mechanism 122 includes a conical sweepjoint 124 and a conical sweep link 126 that is rotationally coupled tothe base link 74 by the conical sweep joint 124. The conical sweep joint124 is operable to selectively rotate the conical sweep link 126 arounda conical sweep axis 128 that intersects the remote center ofmanipulation (RC). The distal end of the conical sweep link 126 supportsthe yaw joint 76. The conical sweep link 126 is configured to positionand orient the yaw joint 76 such that the yaw axis 98 intersects theremote center of manipulation (RC) for all orientations of the conicalsweep link 126 around the conical sweep axis 128. The conical sweepmechanism 122 is operable to reorient the outboard linkage of the remotecenter manipulator 120 relative to the mounting base 72 whilemaintaining the position of the remote center of manipulation (RC)relative to the mounting base 72. Rotation of conical sweep joint 124causes the shaft of surgical instrument 94 to sweep along the surface ofa cone centered on conical sweep axis 128 and having a vertex at theremote center of manipulation (RC). The conical sweep mechanism 122 canbe used in any suitable fashion, for example, as a set-up joint that isused to position/orient the outboard portion of the remote centermanipulator 120 prior to a surgical procedure and/or used toposition/orient the outboard portion of the remote center manipulator120 actively during a surgical procedure. The conical sweep axis 128provides a redundant degree of freedom axis about which the instrumentholder 92 can be rotated around the remote center of manipulation (RC).The conical sweep axis 128 is not aligned with any of the yaw axis 92,the pitch axis 102, or the insertion axis 96. The conical sweep axis 128can be offset from the yaw axis 98 by any suitable angle (e.g., 15degrees in one embodiment). Referring again to FIG. 6 , conical sweepmechanism 122 is optional and may be included or not with variousmanipulator embodiments as described herein. For purposes of thisdescription, conical sweep mechanism 122 may be considered a proximalconical sweep mechanism to distinguish it from other conical sweepmechanisms located more distally in the manipulator (see e.g., FIG. 8 inwhich another, “distal” conical sweep mechanism is shown).

The joint associated with conical sweep mechanism 122 may be powered orunpowered, and if powered can be under active surgeon control as part ofthe teleoperation function or passively controlled by another person inthe operating room. If passively controlled by a person other than thesurgeon, conical sweep mechanism can be used as part of the set-upstructure to properly position the remote center manipulator for surgerybefore and/or during a surgical procedure. In some embodiments, a switch(pushbutton, rocker, etc.) controls conical sweep mechanism 122's motionto move the more distal portions of the manipulator to a desiredposition. And, conical sweep mechanism 122 may rotate a full 360 degreesor more, or its rotation may be limited to less than 360 degrees. Forexample, in one embodiment rotation is limited to within a range ofapproximately 180 degrees, between a straight up (12 o'clock) positionto a straight down (6 o'clock) position. If two or more similarlyconfigured remote center manipulators are located next to one another,then the conical sweep mechanisms 122 of each may be constrained torotate through similar arcs to help eliminate collisions. For example,each conical sweep mechanism 122 would be constrained to rotate to aposition anywhere on the arc running from 12 o'clock through 3 o'clockto 6 o'clock. In other embodiments, conical sweep mechanism 122 isprovided with a gravity compensation balance feature (e.g., by usingcurrent to control motor torque as a function of mechanical loadposition, by using a spring to balance the mechanical load, etc.), whichrenders the mechanical load effectively weightless or low weight foreasy hand positioning. In gravity compensation balance embodiments, abrake typically holds the manipulator in position until released, atwhich time a person moves the manipulator to a desired position, andthen reapplies the brake to hold the manipulator at the new position.

In addition to use for set-up operations, conical sweep mechanism 122may also be tied to the surgeon's active teleoperation control of thesurgical instrument 94. Thus, conical sweep mechanism's motion may occurautomatically as the result of the surgeon's control input or as theresult of, for example, collision avoidance with a nearby object, suchas a second manipulator, the patient, or other operating room equipment.

The various aspects of the remote center manipulators disclosed hereincan be combined in any suitable fashion. For example, FIG. 8 is aperspective schematic representation of a remote center manipulator 130,in accordance with many embodiments, that includes aspects of both theremote center manipulator 70 of FIG. 6 and the remote center manipulator120 of FIG. 7 . Specifically, the remote center manipulator 130 includesthe conical sweep mechanism 122, the conical sweep mechanism 90, and theparallelogram linkage portion 100. As a result, the remote centermanipulator 130 has two redundant degree of freedom axes, specificallythe conical sweep axis 114 and the conical sweep axis 128, about whichthe instrument holder 92 can be rotated around the remote center ofmanipulation (RC). Each of the conical sweep axis 114 and the conicalsweep axis 128 is not aligned with any of the yaw axis 98, the pitchaxis 102, or the insertion axis 96.

Since the remote center manipulator embodiments illustrated in FIGS. 6-8include a yaw axis and one or more conical sweep mechanisms each with anassociated conical sweep axis, and these axes of rotation are allaligned with the remote center of manipulation, the resulting redundantdegrees of freedom allow the instrument shaft to remain stationary inspace (i.e., in the ground reference frame associated with base 72) asthe remote center manipulator is placed in various differentconfigurations. Further, with instrument end effector roll as describedabove, if the end effector orientation is not aligned with insertionaxis 96, then the end effector orientation also can be kept stationaryin space as the remote center manipulator is placed in variousconfigurations. Such remote center manipulators maintain a patientsafety benefit of a hardware-constrained robotic surgical manipulator inwhich the hardware configuration prevents the remote center ofmanipulation from moving with reference to the patient, and suchmanipulators add the benefits of allowing various configurations for anindividual instrument position, a feature useful in avoiding collisionwith adjacent manipulators, the patient, other equipment, and surgicalpersonnel, offering increased clearance between the manipulator andpatient, and offering increased access to the surgical field where theinstruments enter the patient.

It should be easily recognized that if parallelogram linkage portion 100positions insertion axis 96 not perpendicular to axis 98, then as joint76 rotates, instrument 94 also sweeps along the surface of a conecentered on axis 96 with a vertex at the remote center of manipulationin a way similar to the instrument 94 motions as the conical sweepmechanisms rotate as described above. Thus these features provideredundant “yaw-type” degrees of freedom—arbitrarily so called becausethe axis of rotation intersects the remote center of manipulation. But,hardware constrained remote center manipulators in accordance withaspects of the invention are not limited to yaw-type redundant degreesof freedom.

FIG. 9 is a perspective schematic representation of a remote centermanipulator 140, in accordance with many embodiments. The remote centermanipulator 140 includes some of the same components as the remotecenter manipulator 70 of FIG. 6 . The shared components include themounting base 72, the base link 74, the yaw joint 76, the extension link78, the base parallelogram joint 80, the first parallelogram link 82,the first parallelogram joint 84, the second parallelogram link, thesecond parallelogram joint 88, and the instrument holder 92. The remotecenter manipulator 140 as depicted does not include the conical sweepmechanism 90. Instead, the second parallelogram joint 88 rotationallycouples the instrument holder 92 to the second parallelogram link 86 forrotation of the instrument holder 92 relative to the secondparallelogram link 86 about the second joint axis 108. The remote centermanipulator 140 further includes a reorientation mechanism 142 that isoperable to reorient the outboard portion of the remote centermanipulator 140 about an axis 144 that intersects the remote center ofmanipulation (RC). The reorientation mechanism 142 includes a base 146and a movable link 148 that is coupled with and repositionable relativeto the base 146 along a curved path having a constant radius relative tothe remote center of manipulation (RC), thereby limiting thecorresponding motion of the instrument holder 92 to rotation about theremote center of manipulation (RC). In the embodiment shown, the axis144 is coincident with the pitch axis 102. Therefore, as shown,parallelogram linkage portion and reorientation mechanism 142 eachindependently rotate instrument 94 around coincident axes 102,144 at theremote center of manipulation (RC) to provide redundant degrees offreedom. And, the hardware design of remote center manipulator 140physically constrains instrument 94 to rotate at the remote center ofmanipulation (RC). Skilled artisans will understand that othermechanical structures may be used to provide the function schematicallyshown and described for reorientation mechanism 142. Further, one ormore additional reorientation mechanisms having a function similar toreorientation mechanism 142 may be inserted in the chain between base 72and instrument holder 92, so that remote center manipulator 140 hasadditional redundant degrees of freedom.

The reorientation mechanism 142 can also be configured such that theaxis 144 is not aligned with (not coincident with) the pitch axis 102.For example, the reorientation mechanism 142 can be configured such thatthe axis 144 is aligned with the insertion axis 96 and can be configuredsuch that the axis 144 is at any suitable angle relative to either ofthe pitch axis 102 and/or the insertion axis 96.

The joint associated with reorientation mechanism 142 can be powered orunpowered, and if powered can be under active surgeon control or passivecontrol by operating room personnel. If under passive control,reorientation mechanism 142 can be used as a set-up joint prior to asurgical procedure to properly position the remote center manipulator140 for surgery, and/or it can be used during the surgical procedure toactively reorient the outboard linkage while maintaining the position ofthe remote center of manipulation (RC) relative to the mounting base 72and therefore relative to the patient and the incision at whichinstrument 94 enters the patient. In some passive control embodiments, aswitch (e.g., on/off pushbutton, spring rocker, etc.) controlsreorientation mechanism 142 movement, so that a person operates thecontrol to move the remote center manipulator to the desired position.In other passive control embodiments, reorientation mechanism isequipped with a gravity compensation balance feature (e.g., compensationby controlling motor current depending on mechanical load position) sothat the manipulator feels effectively weightless and can be easilymoved by hand. For example, a brake may hold the reorientation mechanism142 in position until released, at which point a person can easilyreposition the reorientation mechanism and then reapply the brake tokeep the manipulator in position.

FIG. 10 is a perspective schematic representation of a remote centermanipulator 150, in accordance with many embodiments. The remote centermanipulator 150 includes aspects of both the remote center manipulator130 of FIG. 8 and the remote center manipulator 140 of FIG. 9 .Specifically, the remote center manipulator 150 includes thereorientation mechanism 142, the conical sweep mechanism 122 (whichoptionally may not be included), the conical sweep mechanism 90 (whichoptionally may not be included), and the parallelogram linkage portion100. As a result, the remote center manipulator 150 has three redundantdegrees of freedom (fewer if one of the conical sweep mechanisms isremoved; more if an additional conical sweep mechanism or reorientationmechanism is added), and these degrees of freedom come from the abilityto rotate around the axis 144 (driven by reorientation mechanism 142),the conical sweep axis 114 (driven by conical sweep mechanism 90), andthe conical sweep axis 128 (driven by conical sweep mechanism 122).While the axis 144 is not coincident to the pitch axis 102 in the remotecenter manipulator 150, the axis 144 can be coincident to the pitch axis102 in alternate embodiments.

Each of the reorientation mechanism 142 and the conical sweep mechanism122 can be used as a set-up joint prior to a surgical procedure and/orcan be used to actively reorient the outboard linkage during thesurgical procedure while physically constraining the position of theremote center of manipulation (RC) relative to the mounting base 72, andtherefore maintaining the position of the remote center of manipulation(RC) relative to the patient. The use of reorientation mechanism 142 aspart of the set-up structure is described above, and conical sweepmechanism 122 can be similarly used.

It should be noted that the various embodiments of the remote centermanipulators are each somewhat narrow so that two or more of thesemanipulators can be located next to one another on a surgical robot andthe spacing between adjacent manipulators can be reduced to allow eachmanipulator to control an instrument near another instrument foreffective surgical instrument placement.

FIG. 11 shows a hardware-constrained remote center manipulator 160 inaccordance with many embodiments. The manipulator 160 includes a baselink 162, a conical sweep link 164, a parallelogram base link 166, aparallelogram first link 168, a parallelogram second link 170, aninstrument holder 172 configured to support a detachable surgicalinstrument (not shown; the instrument shaft passes through the cannula173 shown coupled at the distal end of instrument holder 172), and aconical sweep joint 174. In many embodiments, the base link 162 is heldin a fixed position relative to a patient being operated on via theremote center manipulator 160. The conical sweep link 164 has a conicalsweep link proximal end 176 that is mounted to the base link 162 forrotation of the conical sweep link 164 relative to the base link 162about a first axis 178 that intersects a remote center of motion (RC)defined along the centerline of the cannula through which the instrumentshaft passes. The conical sweep link 164 has a conical sweep link distalend 180 that offset from the first axis 178 and a conical sweep linkbody section 182 that connects the conical sweep link proximal end 176to the conical sweep link distal end 180.

The linkage of the manipulator 160 outboard (distal) of the conicalsweep link 164 is configured to provide selective movement of theinstrument holder 172 that is limited to two-dimensional rotation of theinstrument holder 172 about the remote center (RC) (the surgicalinstrument is not shown). With respect to a first direction of rotationof the instrument holder 172 about the remote center (RC), referred toherein as yaw, the parallelogram base link 166 has a proximal end 184that is mounted to the conical sweep link distal end 180 for rotationrelative to the conical sweep link distal end about a second axis 186that also intersects the remote center (RC). By selectively rotating theparallelogram base link 166 relative to the conical sweep link distalend 180, the linkage of the manipulator 160 outboard of theparallelogram base link 166 is also selectively rotated around thesecond axis 186, thereby selectively rotating the instrument holder 172around the second axis 186.

With respect to a second direction of rotation of the instrument holder172 about the remote center (RC), referred to herein as pitch, theinstrument holder 172 and the parallelogram first and second links 168,170 are coupled so as to form a parallelogram linkage that providesmovement of the instrument holder 172 that is limited to rotation aboutthe remote center (RC) around an axis that is substantiallyperpendicular to the second axis 186 and to a plane of motion of theparallelogram linkage. The parallelogram first link 168 has a proximalend 188 that is rotationally coupled with a distal end 190 of theparallelogram base link 166 via a first parallelogram joint 192. Theparallelogram second link 170 has a proximal end 194 that isrotationally coupled with a distal end 196 of the parallelogram firstlink 168 via a second parallelogram joint 198. The instrument holder 172is coupled with a distal end 200 of the parallelogram second link 170via a third parallelogram joint 202. The second and third parallelogramjoints 198, 202 are rotationally driven by rotation of the firstparallelogram joint 192 so that the first parallelogram link 168, thesecond parallelogram link 170, and the instrument holder 172 form theparallelogram linkage. In the position shown, the first parallelogramlink 168 defines a first parallelogram side 204 extending between thefirst and second parallelogram joints 192, 198; the second parallelogramlink 170 defines a second parallelogram side 206 extending between thesecond and third parallelogram joints 198, 202; and the instrumentholder 172 defines a third parallelogram side 208 extending between thethird parallelogram joint 202 and the remote center (RC). To illustratethe motion of the parallelogram linkage, a rotated first parallelogramside 204R is shown that represents a corresponding rotated position ofthe first parallelogram link 168 relative to the parallelogram base link166, and repositioned second and third parallelogram sides 206R, 208Rare shown that represent positions of the second parallelogram link 170and the instrument holder 172, respectively, corresponding to therotated position of the first parallelogram link 168. As illustrated,rotation of the first parallelogram link 168 relative to theparallelogram base link 166 serves to move the instrument holder 172 sothat the distal end of the third parallelogram side 208 remainscoincident with the remote center of manipulation (RC), thereby pitchingthe instrument holder 172 about an axis substantially perpendicular tothe second axis 186.

The linkage of the manipulator 160 outboard of the conical sweep link164 has an inherent singularity when the shaft of the manipulatedsurgical instrument lines up with the second axis 186 (yaw axis). Evenwhen the surgical instrument shaft does not line up with the second axis186, kinematic conditioning is poor when the angle between the surgicalinstrument shaft and the second axis 186 is low (e.g., 15 degrees orless). Another practical limit to extending the parallelogram linkage tothe extent necessary to align the surgical instrument shaft and thesecond axis 186 is that the resulting length of the manipulator 160 maybe undesirably long for use in the operating room environment.

To address the foregoing issues, the motion of the parallelogram linkagecan be limited, for example, such that the angle of the surgicalinstrument shaft relative to the second axis 186 is constrained to be atleast equal to a suitable angle (e.g., approximately 15 degrees). Withsuch an angle limit, however, for any particular position andorientation of the second axis 186 there is conical volume that thesurgical instrument tip cannot reach. Accordingly, the conical sweepmechanism 122 provides a way of repositioning and reorienting the secondaxis 186 so as to place the inaccessible conical volume to a place inthe patient that the surgeon is not interested in working on. Theconical sweep mechanism 122 can also be used in to rotate the instrumentholder 172 around the first axis 178 as an alternative to rotation ofthe instrument holder 172 around the second axis 186.

A redundant axis and associated redundant degree of freedom on ahardware-constrained remote center manipulator allows the manipulator toposition the surgical instrument in an individual position using any oneof more than one possible combinations of joint angles. The redundantaxis (the axis of the joint that provides the redundant degree offreedom) can therefore be used to avoid collisions with an adjacentmanipulator, patient anatomy, or equipment (such as the operatingtable). When the redundant axis is mechanically constrained to passthrough the remote center of manipulation (RC), the redundant axis canbe reoriented during surgery without risk of moving the remote center ofmanipulation (RC) relative to the patient.

The conical sweep joint 174 couples the distal end 200 of the secondparallelogram link 170 to the instrument holder 172. The conical sweepjoint 174 is operable to selectively vary the orientation of theinstrument holder 172 relative to the second parallelogram link 170about a third axis 210 that intersects the remote center (RC). Theability to change the orientation of the instrument holder 172 relativeto the second parallelogram link 170 can be used to avoid interferencebetween the instrument holder 172 and an adjacent manipulator, to avoidinterference between the instrument holder 172 and the patient, and toincrease the range of motion of the instrument holder 172. In theembodiment shown, the third axis 210 is coincident with the thirdparallelogram side 208 thereby ensuring that third parallelogram side208 does not change in length in response to rotation of the instrumentholder 172 about the third axis 210.

FIG. 12 further illustrates the conical sweep joint 174. As shown, thethird axis 210 is not aligned with a centerline 228 of a surgicalinstrument (not shown) supported by the instrument holder 172, alongwhich the surgical instrument is inserted and withdrawn, and aroundwhich the surgical instrument shaft rolls. The angular offset betweenthe third axis 210 and the centerline 228 allows rotation of the conicalsweep joint 174 to reorient the surgical instrument relative to theremote center (RC), thereby allowing the surgical instrument to reachdifferent regions within the patient. And as described above, incombination the pitch motion function of the parallelogram mechanism,rotation of the conical sweep joint 174 can maintain a position andorientation of the surgical instrument with reference to the remotecenter of motion (RC), allowing the repositioning of the instrumentholder 172 to avoid interfering with an adjacent instrumentholder/surgical instrument.

FIG. 13A, FIG. 13B, and FIG. 13C illustrate the range of motion that theconical sweep joint 174 provides. In FIG. 13A, the conical sweep joint174 is in a centered configuration in which the instrument holder 172 isaligned with the second parallelogram link 170. In FIG. 13B, the conicalsweep joint 174 is shown fully rotated in one direction, therebyorienting the instrument holder 172 in the direction shown. And in FIG.13C, the conical sweep joint 174 is shown fully rotated in the oppositedirection, thereby orienting the instrument holder 172 in the oppositedirection shown. As illustrated, the different possible orientations ofthe instrument holder 172 provided by the conical sweep joint 174 servesto provide corresponding different insertion directions for a surgicalinstrument (not shown) supported by the instrument holder 172.Similarly, the redundant degree of freedom that conical sweep joint 174provides allows a range of joint positions for the manipulator for eachindividual instrument position. Although not illustrated, it can be seenthat the proximal conical sweep joint shown in FIG. 11 provides asimilar function. And in addition, the two conical sweep joints actingtogether can offset the yaw joint and parallelogram mechanism to oneside or the other while the instrument remains stationary. As mentionedabove, rolling the end effector relative to the instrument body (e.g.,rolling the end effector on the shaft, or rolling the entire shaft withthe end effector attached) allows the end effector to stay stationary inspace as the manipulator moves. Thus, during telesurgery the manipulatormotions that exploit the advantages of the redundant degrees of freedomare transparent to the surgeon, who does not perceive any correspondingsurgical end effector movement.

FIG. 14A shows a first Sine/Cosine link 228 and a second Sine/Cosinelink 230 that rotationally couple some embodiments of the secondparallelogram joint 198 and the third parallelogram joint 200 of themanipulator 160. The first and second Sine/Cosine links 228, 230 are sonamed to reflect the way the links 228, 230 are coupled to theparallelogram joints 198, 200. As illustrated at the secondparallelogram joint 198, the connections between the first and secondSine/Cosine links 228, 230 and the second parallelogram joint 198 areoffset by 90 degrees, with the connection between the first and secondSine/Cosine links 228, 230 and the third parallelogram joint 200 beingsimilarly configured. While a 90-degree connection offset is preferred,other offset angles can also be used. The connection offset ensures thatat least one of the links 228, 230 is always offset from a centerline232 passing through both of the first and second parallelogram joints198, 200, so as to always have an offset necessary to transfer torquebetween the second and third parallelogram joints 198, 200. Byconnecting each end of each of the first and second Sine/Cosine links228, 230 to the parallelogram joints 198, 200 at the same angularorientation and radial distance, transfer or rotary motion between thesecond and third parallelogram joints 198, 200 can be accomplished in apositive and smooth manner.

In many embodiments, the length of the first and second Sine/Cosinelinks 228, 230 is adjustable to better match the length between couplingpoints with the second and third parallelogram joints 198, 200. Becausethe linkage is kinematically over-constrained, geometric deviations inthe mechanical components such as lengths, angles, or operating radiimay result in the development of high forces and/or a force fight insome or all of the components. The first Sine/Cosine link 228 includes afirst link proximal portion 234 and a first link distal portion 236,which are fastened together at a first link joint 238. Likewise, thesecond Sine/Cosine link 230 includes a second link proximal portion 240and a second link distal portion 242, which are fastened together at asecond link joint 244. The first link and second link joints 238, 244are configured such that the length of each of the first and secondSine/Cosine links 228, 230 can be varied to match the specific length ofthe second parallelogram link 170 on which they are installed. Forexample, the first link proximal portion 234 and the first link distalportion 236 can first be connected to the second parallelogram joint 198and to the third parallelogram joint 200, respectively, and then coupledto each other via the first link joint 238 to match the specific lengthof the second parallelogram link 170 in which they are installed.

FIG. 14B shows a third Sine/Cosine link 246 and a fourth Sine/Cosinelink 248 that rotationally couple the first parallelogram joint 192 andthe second parallelogram joint 198 of the manipulator 160. The third andfourth Sine/Cosine links 246, 248 are configured and connected to theparallelogram joints 192, 198 similar to the first and secondSine/Cosine links 228, 230, so the same description applies and will notbe repeated here. FIG. 14B illustrates oriented flexures 250, 252, whichare configured to reduce operational force-fight levels in the third andfourth Sine/Cosine links 246, 248 (and can also be used to reduceoperational force-fight levels in the first and second Sine/Cosine links228, 230). Each of the oriented flexures 250, 252 are configured ascantilevered beams that have a stiff orientation in which the orientedflexure is aligned with the attached Sine/Cosine link (as shown at theconnection of the fourth Sine/Cosine link 248 to the secondparallelogram joint 198) and a compliant orientation in which theoriented flexure is oriented perpendicular with the attached Sine/Cosinelink (as shown in the connection of the third Sine/Cosine link 246 tothe first parallelogram joint 192). The oriented flexures 250, 252 areconfigured such that the stiffness of the load path provided ismaximized when the attached Sine/Cosine link provides maximum mechanicaladvantage for the transfer of torque and the stiffness of the load pathprovided is minimized when the attached Sine/Cosine link providesminimum mechanical advantage for the transfer of torque.

The use of Sine/Cosine links as illustrated in FIGS. 14A and 14B isoptional, and as described above other well-known ways (e.g., gears,belts, etc.) exist to couple the parallelogram links so that theparallelogram mechanism functions properly.

FIG. 15 illustrates another approach for the implementation of aredundant axis that passes through the remote center of manipulation(RC) and the associated redundant mechanical degree of freedom. FIG. 15shows a remote center manipulator 260, in accordance with manyembodiments, that includes a mounting base 262 that includes a curvedfeature 264 having a constant radius of curvature relative to the remotecenter of manipulation (RC) and along which a base link 266 of theoutboard (proximal) linkage of the manipulator 260 can be repositioned.The outboard linkage is mounted to the base link 266, which includes a“yaw” joint feature, for rotation about a first axis 268 that intersectsthe remote center of manipulation (RC). The base link 266 is interfacedwith the curved feature 264 such that the base link 266 is constrainedto be selectively repositioned along the curved feature 264, therebymaintaining the position of the remote center of manipulation (RC)relative to the mounting base 262, which is held in a fixed positionrelative to the patient. The curved feature 264 is configured such thatmovement of the base link 266 is limited to rotation about a second axis270 that intersects the remote center of manipulation (RC). By changingthe position of the base link 266 along the curved feature 264, theorientation of the outboard linkage of the manipulator 260 relative tothe patient can be varied, thereby providing for increased range ofmotion of the surgical instrument manipulated by the remote centermanipulator 260. Parallelogram mechanism 272 provides rotation aroundaxis 274. It can be seen that as the entire parallelogram mechanismrotates around axis 268, axes 270 and 274 can be made coincident. It canfurther be seen that the embodiment shown in FIG. 15 is similar to theconfiguration of the embodiment shown in FIG. 9 , with parallelogrammechanisms 140 and 272 being analogous, and yaw joints 76 and 266 areanalogous.

FIG. 16 illustrates another approach for the implementation of aredundant axis that passes through the remote center of manipulation(RC), providing an associated redundant degree of freedom. FIG. 16 showsa remote center manipulator 280, in accordance with many embodiments,that includes a mounting base 282 that includes a closed-loop curvedfeature 284 inside which a base link 286 of the outboard (distal)linkage of the manipulator 280 can be repositioned. As shown, centralmount element 285 rotates inside closed-loop curved feature 284. Baselink 286 is mounted on the central mount element 285 to be orientedsomewhat inward toward the remote center of manipulation. The outboardlinkage is mounted to the base link 286 for rotation about a first axis288 that intersects the remote center of manipulation (RC). Theclosed-loop curved feature 284 is configured such that, for allpositions of the base link 286 around the curved feature 284, theposition of the remote center of manipulation (RC) remains fixedrelative to the mounting base 282, which is held fixed relative to thepatient. The closed-loop curved feature 284 is circular and isaxially-symmetric about a second axis 290 that intersects the remotecenter of manipulation (RC). By changing the position of the base link286 around the closed-loop curved feature 284, the orientation of theoutboard linkage of the manipulator 280 relative to the patient can bevaried, thereby providing for increased range of motion, arm-to-arm orarm-to-environment collision avoidance, and/or kinematic singularityavoidance for the remote center manipulator 280. A “partial circle”feature or a full circular feature where the mounting base onlytraverses a portion of the circle can also be used. It can be seen thatcurved feature 284 and its associated central mount feature 285 act as aconical sweep joint. Thus the embodiment shown in FIG. 16 is similar tothe embodiment shown in FIG. 7 , with conical sweep joints 122 and 284being analogous, and yaw joints 76 and 286 being analogous.

FIG. 17 is a perspective schematic representation of a remote centermanipulator 300, in accordance with many embodiments. The remote centermanipulator 300 includes some of the same components as the remotecenter manipulator 70 of FIG. 6 . The shared components include themounting base 72, the base link 74, the yaw joint 76, the baseparallelogram joint 80, the first parallelogram link 82, the firstparallelogram joint 84, the second parallelogram link 86, the secondparallelogram joint 88, and the instrument holder 92. The remote centermanipulator 300 can also include the conical sweep assembly 90 (notshown). The remote center manipulator 300 includes an offset extensionlink 302 that offsets the parallelogram linkage portion 100 from the yawaxis 98, thereby orienting the pitch axis 102 to be non-perpendicular tothe yaw axis 98. Offsetting the parallelogram linkage portion 100 fromthe yaw axis 98 can be used to reduce the volume swept by the remotecenter manipulator 300 as it is rotated around the yaw axis 98 by theoperation of the yaw joint 76, thereby increasing clearance to thepatient and/or increasing clearance to an adjacent remote centermanipulator(s). As a non-limiting example, the offset angle is 2.7degrees in some embodiments. Although the additional clearance providedby the offset appears to be small, it can be significant during surgery,since several such manipulators are typically closely positioned tocontrol instruments inserted into the patient. Even more significant,the increased clearance from the patient can allow an increased range ofmotion for the instrument end effector inside the patient, which allowssurgeons to reach just a little farther if necessary to reach tissue fortherapeutic purposes.

FIG. 18 is a perspective schematic representation of a remote centermanipulator 310, in accordance with many embodiments. The remote centermanipulator 310 includes aspects of both the remote center manipulator300 of FIG. 17 and the remote center manipulator 140 of FIG. 9 .Specifically, the remote center manipulator 310 includes thereorientation mechanism 142, the offset extension link 302, and theparallelogram linkage portion 100. As a result, the remote centermanipulator 310 has one redundant axis and associated degree of freedom,specifically the axis 144 (which in the embodiment shown is not alignedwith the pitch axis 102) about which the instrument holder 92 can berotated around the remote center of manipulation (RC). The reorientationmechanism 142 can be used as a set-up joint prior to a surgicalprocedure and/or can be used to actively reorient the outboard (distal)linkage during the surgical procedure while maintaining the position ofthe remote center of manipulation (RC) relative to the mounting base 72and therefore maintaining the position of the remote center ofmanipulation (RC) relative to the patient.

Any suitable combination of the remote center manipulator aspectsdisclosed herein can be employed. For example, a remote centermanipulator can include any suitable combination of the reorientationmechanism 142, the conical sweep mechanism 122, the offset extensionlink 302, and the conical sweep mechanism 90. FIG. 19 shows a remotecenter manipulator 312 that includes the reorientation mechanism 142,the offset extension link 302, the parallel linkage portion 100, and theconical sweep mechanism 90.

FIG. 20 shows a remote center manipulator 320, in accordance with manyembodiments. The manipulator 320 includes five units that are configuredto be replaceable in the field. The five field replaceable units (FRUs)include a yaw/pitch drive assembly 322, an extension 324 having anextension proximal end 326 and an extension distal end 328, a firstparallelogram link 330 having a first link proximal end 332 and a firstlink distal end 334, a second parallelogram link 336 having a secondlink proximal end 338 and a second link distal end 340, and aninstrument holder 342.

The yaw/pitch drive assembly 322 includes a mounting base 344 and ayaw/pitch housing 346 that is coupled with the mounting base 344 torotate around a yaw axis 348 that intersects a remote center ofmanipulation (RC) having a fixed position relative to the mounting base344. The mounting base 344 allows the remote center manipulator 320 tobe mounted and supported by set-up arms/joints of a cart mount, aceiling mount, floor/pedestal mount, or other mounting surface. Bysupporting the mounting base 344 in a fixed position and orientationrelative to a patient, the remote center of manipulation (RC) is heldfixed relative to the patient, thereby providing an entry point for asurgical instrument held by the instrument holder 342 to be manipulatedwithout imposing without imposing potentially dangerous forces onpatient tissue at the entry location of the surgical instrument. Theyaw/pitch drive assembly 322 is operable to selectively rotate theyaw/pitch housing 346 relative to the mounting base 344, therebyrotating the outboard portion of the remote center manipulator 320 suchthat the instrument holder 342 is rotated (yawed) around the yaw axis348 without moving the remote center of manipulation (RC) relative tothe mounting base 344.

The extension 324 provides support to a base joint 350 of aparallelogram linkage portion of the remote center manipulator 320. Theextension proximal end 326 is fixedly mounted to the yaw/pitch housing346. The first link proximal end 332 is coupled with the extensiondistal end 328 via the base joint 350 such that the first parallelogramlink 330 rotates around a first offset pitch axis 352 relative to theextension 324. The first parallelogram link 330 is offset to a side ofthe extension 324 such that the first parallelogram link 330 moves in aplane of motion offset from the extension 324 and can therefore rotateinto alignment and past the extension 324 without interfering with theextension 324.

The parallelogram linkage portion of the remote center manipulator 320includes the first parallelogram link 330, the second parallelogram link336, and the instrument holder 342. The second link proximal end 338 iscoupled with the first link distal end 334 via a first intermediatejoint 354 such that the second parallelogram link 336 rotates relativeto the first parallelogram link 330 around a second offset pitch axis356 that is parallel to the first offset pitch axis 352 and fixedrelative to the first link distal end 334. The second parallelogram link336 is offset to a side of the first parallelogram link 330 such thatthe second parallelogram link 336 moves in a plane of motion offset fromthe first parallelogram link 330 and can therefore rotate into alignmentand past the first parallelogram link 330 without interfering with thefirst parallelogram link 330. The instrument holder 342 is coupled withthe second link distal end 340 via a second intermediate joint 358 suchthat the instrument holder 342 rotates relative to the secondparallelogram link 336 around a third offset pitch axis 360 that isparallel to the first offset pitch axis 352 and fixed relative to thesecond link distal end 340. Rotation of each of the first and secondintermediate joints 354, 358 is tied to rotation of the base joint 350such that the first parallelogram link 330, the second parallelogramlink 336, and the instrument holder 342 are constrained to move as aparallelogram linkage, thereby rotating (pitching) the instrument holderabout a pitch axis 362 that intersects the remote center of manipulation(RC).

The instrument holder 342 includes a carriage assembly 364 to which asurgical instrument is mounted. The instrument holder 342 includes aninsertion drive mechanism operable to translate the carriage assembly364 along an insertion axis 366, thereby controlling insertion of thesurgical instrument through the remote center of manipulation (RC). Thesurgical instrument typically passes through a cannula 368, which ismounted at the distal end of instrument holder 342, and for which theremote center of manipulation (RC) is defined along a centerlinecoincident with axis 366.

FIG. 21 shows a top view of the remote center manipulator 320. As shown,the yaw axis 348 and the pitch axis 366 are angularly offset by an angleother than 90 degrees. In the embodiment shown, the yaw axis 348 and thepitch axis 366 are angularly offset by 87.3 degrees. By offsetting theyaw axis 348 and the pitch axis 366 by an angle other than 90 degrees,the operating space envelope (swept volume) of the remote centermanipulator 320 for rotation about the yaw axis 348 is reduced relativeto the use of a 90 degree angular offset between the yaw axis 348 andthe pitch axis 366. This reduction of the swept volume of the remotecenter manipulator 320 for rotation about the yaw axis 348 isillustrated in FIG. 22 . For the embodiment shown, the angular offset of87.3 degrees produces a relatively smaller swept volume 368 having adiameter at the base joint 350 of 7.95 inches. In comparison, when a yawaxis 370 having a 90 degree angular offset from the pitch axis 366 isused it produces a relatively larger swept volume 372 having a diameterat the base joint 350 of 8.98 inches. Accordingly, the use of the 87.3degree angular offset produces about 0.5 inches in additional patientclearance that, as described above, can be significant for surgicalperformance.

FIG. 23 is a side view of the remote center manipulator 320 in which theinstrument holder 342 is pitched back to a maximum amount. In theconfiguration shown, the first parallelogram link 330 has been swung toa position just past being aligned with the extension link 324 and thesecond parallelogram link 336 has been swung to a position just pastbeing aligned with the first parallelogram link 330, thereby orientingthe insertion axis 366 to an angular offset of 75 degrees from aperpendicular 374 to the yaw axis 348. While the remote centermanipulator 320 can be configured to achieve even greater maximum pitchback angle, for example, by increasing the length of the extension link324 such that the instrument holder 342 does not come into contact withthe yaw/pitch housing 346, the additional pitch back angle gained maynot be of practical value given that the kinematics of the remote centermanipulator 320 with regard to yawing of the instrument holder 342relative to the remote center of manipulation (RC) becomes increasinglypoorly conditioned when the angle between the insertion axis 366 and theyaw axis 348 is reduced below 15 degrees.

Other variations are within the spirit of the present invention. Thus,while the invention is susceptible to various modifications andalternative constructions, certain illustrated embodiments thereof areshown in the drawings and have been described above in detail. It shouldbe understood, however, that there is no intention to limit theinvention to the specific form or forms disclosed, but on the contrary,the intention is to cover all modifications, alternative constructions,and equivalents falling within the spirit and scope of the invention, asdefined in the appended claims.

The use of the terms “a” and “an” and “the” and similar referents in thecontext of describing the invention (especially in the context of thefollowing claims) are to be construed to cover both the singular and theplural, unless otherwise indicated herein or clearly contradicted bycontext. The terms “comprising,” “having,” “including,” and “containing”are to be construed as open-ended terms (i.e., meaning “including, butnot limited to,”) unless otherwise noted. The term “connected” is to beconstrued as partly or wholly contained within, attached to, or joinedtogether, even if there is something intervening. Recitation of rangesof values herein are merely intended to serve as a shorthand method ofreferring individually to each separate value falling within the range,unless otherwise indicated herein, and each separate value isincorporated into the specification as if it were individually recitedherein. All methods described herein can be performed in any suitableorder unless otherwise indicated herein or otherwise clearlycontradicted by context. The use of any and all examples, or exemplarylanguage (e.g., “such as”) provided herein, is intended merely to betterilluminate embodiments of the invention and does not pose a limitationon the scope of the invention unless otherwise claimed. No language inthe specification should be construed as indicating any non-claimedelement as essential to the practice of the invention.

Preferred embodiments of this invention are described herein, includingthe best mode known to the inventors for carrying out the invention.Variations of those preferred embodiments may become apparent to thoseof ordinary skill in the art upon reading the foregoing description. Theinventors expect skilled artisans to employ such variations asappropriate, and the inventors intend for the invention to be practicedotherwise than as specifically described herein. Accordingly, thisinvention includes all modifications and equivalents of the subjectmatter recited in the claims appended hereto as permitted by applicablelaw. Moreover, any combination of the above-described elements in allpossible variations thereof is encompassed by the invention unlessotherwise indicated herein or otherwise clearly contradicted by context.

All references, including publications, patent applications, andpatents, cited herein are hereby incorporated by reference to the sameextent as if each reference were individually and specifically indicatedto be incorporated by reference and were set forth in its entiretyherein.

What is claimed is:
 1. A manipulator comprising: means for inserting asurgical instrument along an insertion axis, wherein a remote center ofmanipulation is defined on the insertion axis; means for changing apitch orientation of the surgical instrument around a pitch axis thatintersects the remote center of manipulation; means for changing a yaworientation of the surgical instrument around a yaw axis that intersectsthe remote center of manipulation, wherein the yaw axis is orthogonal tothe pitch axis; and means for changing an orientation of the surgicalinstrument around a conical sweep axis that intersects the remote centerof manipulation, wherein the conical sweep axis is transverse to thepitch axis and is offset from the yaw axis.
 2. The manipulator of claim1, wherein the means for changing the orientation of the surgicalinstrument around the conical sweep axis is between the means forinserting the surgical instrument along an insertion axis and the meansfor changing the pitch orientation of the surgical instrument around thepitch axis.
 3. The manipulator of claim 1, further comprising means forsupporting the manipulator, wherein the means for changing theorientation of the surgical instrument around the conical sweep axis isbetween the means for changing the yaw orientation of the surgicalinstrument around the yaw axis and the means for supporting themanipulator.
 4. The manipulator of claim 1, further comprising: meansfor changing an orientation of the surgical instrument around a secondconical sweep axis that intersects the remote center of manipulation,wherein the second conical sweep axis is transverse to the pitch axisand is offset from the yaw axis.
 5. The manipulator of claim 4, furthercomprising means for supporting the manipulator, wherein: the means forchanging the orientation of the surgical instrument around the conicalsweep axis is between the means for inserting the surgical instrumentalong an insertion axis and the means for changing the pitch orientationof the surgical instrument around the pitch axis; and the means forchanging the orientation of the surgical instrument around the secondconical sweep axis is between the means for changing the yaw orientationof the surgical instrument around the yaw axis and the means forsupporting the manipulator.
 6. The manipulator of claim 4, furthercomprising: means for reorienting the means for changing the pitchorientation of the surgical instrument around a reorientation axis. 7.The manipulator of claim 1, wherein the means for changing theorientation of the surgical instrument around the conical sweep axis isunder surgeon control as part of a teleoperation function.
 8. Themanipulator of claim 1, wherein the means for changing the orientationof the surgical instrument around the conical sweep axis occursautomatically in response to a surgeon's control input or to providecollision avoidance.
 9. The manipulator of claim 1, further comprising:means for reorienting the means for changing the pitch orientation ofthe surgical instrument around a reorientation axis.
 10. The manipulatorof claim 1, further comprising means for setting up and fixing theremote center of manipulation at a fixed position.
 11. The manipulatorof claim 1, wherein the means for changing the orientation of thesurgical instrument around a conical sweep axis is configured to providea degree of freedom that is redundant with at least one of the means forchanging the pitch orientation of the surgical instrument and the meansfor changing the yaw orientation of the surgical instrument.
 12. Amanipulator comprising: means for inserting a surgical instrument alongan insertion axis, wherein a remote center of manipulation is defined onthe insertion axis; means for changing a yaw orientation of the surgicalinstrument around a yaw axis that intersects the remote center ofmanipulation; means for changing a pitch orientation of the surgicalinstrument around a pitch axis that intersects the remote center ofmanipulation, wherein the pitch axis is transverse to the yaw axis; andmeans for reorienting the means for changing the pitch orientation ofthe surgical instrument around a reorientation axis so that the pitchaxis remains intersected with the remote center of manipulation and theremote center of manipulation remains in a fixed position.
 13. Themanipulator of claim 12, further comprising means for changing anorientation of the surgical instrument around a conical sweep axis thatintersects the remote center of manipulation, wherein the conical sweepaxis is orthogonal to the pitch axis and is offset from the yaw axis.14. The manipulator of claim 13, wherein the means for changing theorientation of the surgical instrument around the conical sweep axis isbetween the means for inserting the surgical instrument along aninsertion axis and the means for changing the orientation of thesurgical instrument around the pitch axis.
 15. The manipulator of claim13, further comprising means for supporting the manipulator, wherein themeans for changing the orientation of the surgical instrument around theconical sweep axis is between the means for changing the orientation ofthe surgical instrument around the yaw axis and the means for supportingthe manipulator.
 16. The manipulator of claim 13, wherein the means forchanging the orientation of the surgical instrument around the conicalsweep axis is between the means for changing the orientation of thesurgical instrument around the yaw axis and the means for reorientingthe means for changing the pitch orientation of the surgical instrumentaround the reorientation axis.
 17. The manipulator of claim 12, furthercomprising means for setting up and holding the remote center ofmanipulation at a fixed position.
 18. The manipulator or claim 12,wherein the means for reorienting is configured to provide a degree offreedom that is redundant with at least one of the means for changingthe yaw orientation of the surgical instrument and the means forchanging the pitch orientation of the surgical instrument.